Welcome to my blog

Acupuncture specialist for Fertility, Facial rejuvenation, Pain relief.
Based at Kensington Central London.Qualified as a medical doctor in Western medicine over 20 years ago in China with a Medical degree from Beijing, China and a PhD degree from the UK. Many year research and clinical experiences

Doctor who is passionate about acupuncture

I love what I do, I am good at it and I am always there for my patients. If you come and see me, you will know why I am standing out.
This blog is to introduce latest development and research of acupuncture and offer a chance of awareness of more treatment options for your condition. The blog is for information purpose only.

About Me

My photo

My specialised areas include fertility for women and men, facial rejuvenation, acne, various pain conditions, chronic fatigue and hormone regulation with acupuncture treatment.

Practice contact for appointments and address

Kensington: for appointments (Mondays, Fridays, Saturdays, and Thursdays) at Anamaya center Kensington please call at 02030110355 or email at info@anamaya.co.uk

Address: 1 Adam and Eve Mews, Kensington, London W8 6UG

2 min walk from High Street Kensington underground station

My background: I became a qualified medical doctor in Western medicine 20 years ago in China and was well trained in Western medicine together with Chinese medicine in the best Medical University in Beijing, China. Also I was trained with Dr Zheren Xuan--famous orthopedics expert and founder of soft tissue surgery in China. I am dedicated to treat patients with acupuncture and am recognized as one of the world leading acupuncture specialists.

I obtained a PhD degree in the University of Leeds in the UK.

I had post doctoral training and worked as a senior researcher in St George's hospital, London, UK.

I had frequently presented my research findings in the top international conferences in the field.

I have many publications including ebooks and articles.

I have many year clinical experiences. Over the years of practicing, I have developed unique treatment approaches for infertility, skin aging, acne, vulvodynia, neck pain, headache, migraine, shoulder pain, back pain, fatigue and hot flushes etc to achieve best treatment results. My devotion and skills are highly praised by my patients. 


Monday, 6 October 2014

Pudendal neuralgia with acupuncture treatment

Pudendal neuralgia was first described in 1987. It is a severely painful and disabling neuropathic condition, affecting both men and women. This leads to a burning, tingling, or itching sensation in the clitoris/penis, vulva/scrotum, perineum, and rectum, especially when sitting. Symptoms are frequently on one side, however, in patients presenting with both sides, there is often a more affected side. The pain could be present in the lower abdomen, posterior thigh, and lower back. Another common symptom is the sensation of a foreign body in the vagina, perineum or rectum. Defecation and urination can also be painful. Urinary or fecal incontinence may develop from decreased sphincter tone if motor function is affected.

Treatments are often used include muscle relaxants, anticonvulsants, and analgesics or steroid injections to pudendal nerve(s). Have you tried acupuncture to treat this condition? Do you know acupuncture can help reducing the pudendal neuralgia pain?

Monday, 22 September 2014

Irritable bowel syndrome (IBS), acupuncture can help

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by chronic or recurrent abdominal pain or discomfort. The symptoms include chronic abdominal pain, which is often associated with diarrhoea, constipation or bloating. Bowel habit is changed often with increased passing stool frequency and passage of mucus. IBS affects about 20% adult population globally and their quality of life is affected.

IBS is caused by multiple factors, including intestinal motility and intestinal smooth muscle functional disturbance, visceral paresthesia, alterations in the brain-gut axis, psychological factors, gastrointestinal hormones, and intestinal infection. Some evidences suggested that neurohormonal and immune responses to physiological stimulation or psychological stress etc are possible risk factors.

There is no universally accepted satisfactory treatment for this condition. No drug is effective in treating all the symptoms of IBS. Very recently, a study has analysed existing data and suggested that acupuncture improves the symptoms of IBS, including abdominal pain and distension, sensation of incomplete defecation, times of defecation per day, and state of stool. No serious adverse events associated with acupuncture. Acupuncture might modulate pain in IBS by two actions: (1) modulation of serotonin pathway at insula; and (2) modulation of mood and affection in the higher cortical center via the ascending pathway at the pulvinar and medial nucleus of the thalamus (3) Improvement in pain in IBS was positively associated with increased parasympathetic tone in the acupuncture group. They suggested that acupuncture exhibits clinically and statistically significant control of IBS symptoms.

In TCM differentiation, Liver Qi Stagnation and Damp Heat were the most commonly reported patterns for IBS. There was lack of standardization of acupuncture treatments for patients with IBS. A study on 113 patients with IBS has shown that 126 acupuncture points used, a distinct core and supporting group of points was associated with each primary pattern and each practitioner also utilized a distinct core and supporting group of points that reflected his/her preferences.

Recently a clinical trial was performed to study the effect of acupuncture on patients with IBS. In this study, 12 weeks of acupuncture was offered on weekly basis. The result has shown that there was a statistically significant difference between groups at three months favouring acupuncture with a reduction in IBS Symptom Severity Score. The number needed to treat for successful treatment was six, based on 49% success in the acupuncture group vs. 31% in the control group, a difference between groups of 18%. This benefit largely persisted at 6, 9 and 12 months.

There was a case study about acupuncture treatment on IBS published in Chinese acupuncture journal. The researchers compared trimebutine maleate, a commonly used drug for IBS. Two acupuncture points ST25 and BL25 were used for daily acupuncture treatment. The symptoms including duration and frequency of abdominal pain, morbidity of abnormal stool, defecation abnormality, stool mucus and score of bloating were assessed. The result showed that there was significant change for both groups which suggested that both acupuncture and the drug are effective on IBS. The effective rate for acupuncture group is higher than for the drug group which indicates that acupuncture was more effective compared to the drug.

Li H et al compared the effect of acupuncture with medicine for diarrhea-predominant IBS. 70 patients with IBS were allocated into two groups acupuncture group and medicine group. In acupuncture group, patients received acupuncture 3-4 treatment per week for 4 weeks. The points selected were Tianshu (ST 25), Zusanli (ST36), Shangjuxu (ST37), Sanyinjiao (SP6), Taichong (LR3) etc. The electric stimulation was added at bilateral ST25. Pinaverium (Dicetel) was given in medicine group. The clinical symptom score and IBS syndrome quality of life (IBS-QOL) score were assessed before and after treatment. The efficacy and the recurrence rate were assessed. Result showed that the symptom score and IBS-QOL score were all improved significantly after treatment in both groups. The efficacy in acupuncture group was greater. 3 month follow up showed that recurrence rate in acupuncture group was lower than medicine group.

Lu YH and Tang XD also showed that acupuncture is effective in 21 patients with IBS diarrhea. The patients received acupuncture 2-3 times a week. 8 treatments made up for one course. Symptoms after acupuncture treatment significantly reduced compared with that before the treatment. The total effective rate was 52.4% after first course and 90.5% after second course.

Sun JH et al also showed effectiveness of acupuncture in 63 patients with diarrhea predominant IBS. They showed acupuncture treatment reduced the severity and frequency of symptoms including abdominal pain, diarrhea, abdominal distension etc. They also showed that the quicker initiation of effect, the more evident clinical improvement in symptoms along the increase in treatment duration as well as the more significant elevation of QOL.

Chao and Zhang analised data from 1966 to 2013 to study the effect of acupuncture on IBS. There were 5 out of 6 high quality studies found. They found acupuncture was beneficial for patients with IBS though further studies are needed to confirm the conclusion because there were only a few studies met the criteria.

References

Chao and Zhang World J Gastroenterol (2014) 20:1871-1877
Shi ZM et al Zhongguo Zhen Jiu (2011) 31:607-9
Li H Zhongguo Zhen Jiu (2012) 32:679-82
Lu YH and Tang XD Zhongguo Zhen Jiu (2011) 31:975-7
Sun JH et al Chin J Integr Med (2011) 17:780-5
Stuardi T and MacPherson H J Altern Complment Med (2012) 18:1021-7
MacPherson H et al BMC Gastroenterol (2012) 12:150

Friday, 19 September 2014

How to boost male fertility?

Sperm tests

If you have been trying for conceiving for long time without success, the semen should be tested to check if sperm are good. Sperm are tested by semen analysis. What is semen? Semen is the thick, white fluid released during ejaculation which comes from three sources: the vas deferences, the seminal vesicles and prostate. This liquid protects sperm cells which are comprised in semen. What are sperm cells like? Sperm cells are unique. They have head, neck and tail. The sperm head is oval shape containing highly compact DNA and enzymes required for penetrating egg shell for fertilization. The tail is responsible for sperm movement. Head and tail is connected by neck. Sperm parameters include sperm count over 20 million per ml or more. Over 50% of sperm should show normal forward movement 1 hour after collection. Over 30% of sperms should be in normal shape. Total semen volume is 1.5 ml to 6 ml. Normal semen pH range from 7.2-7.8. Liquefaction time is 20-30 min after collection. There are no white blood cells or bacteria in the semen.

Do you know that semen quality is related to life expectancy?

Semen quality is known to be a marker of fertility, and a sperm concentration of up to 40 million/mL has been found to increase the probability of conception in a menstrual cycle. Is there association between semen quality and long-term health effects? The Copenhagen Sperm Analysis Laboratory analysed semen samples from 51543 men between 1963-2001 and they found that mortality decreased as the sperm concentration increased up to a threshold of 40 million/mL and no further decrease in mortality above the threshold. Mortality decreased as the percentages of motile and morphologically normal spermatozoa increased in a dose-response manner. They suggested that good semen quality may be a more general biomarker of overall health.

Which hormones are involved in sperm production?

Sperm production is hormonally driven. There are four hormones involved in sperm production: gonadotropin-releasing hormone (GnRH), follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone. GnRH is produced in hypothalamus and acts on pituitary gland stimulating FSH and LH releasing. FSH is produced in pituitary gland (a part of the brain) and acts on testis stimulating sperm production. LH is also produced in pituitary gland and acts on testis stimulating testosterone production. Testosterone is produced in the testis and it supports sperm production. Without testosterone sperm will not develop and the matured sperm will not be released.

How to boost male fertility?

Male fertility can be reduced by stress. The stress includes emotional, physical and financial. Stress level will increase from frequent travelling, a long illness, long working hours and major life changes. How to get rid of stress? Many things can help reduce stress to help your body relax. For example, exercise, massage or of course acupuncture on a regular basis. Other some simple things are also help reduce stress such as eating well, sleeping well, stop of smoking and stop of drinking alcohol, reducing coffee consumption, losing some weight if you are overweight, avoid hot bath etc.

Keeping good nutrition and balanced diet is the best way to improve male fertility. Whole grains, plenty of fruits and vegetables and plenty of nuts, low fat and low sugar help improving male fertility. Don’t forget acupuncture increases sperm count.

What food and supplements are good to boost male fertility?

One in six couples have difficulty to conceive. Male factors contribute half of the cases. To boost male fertility, some food and supplements can help based on recent research.

Organic food: it is better to go for organic or hormone free food and avoid hormone containing diary products and meats. Synthetic estrogens are widely used in the livestock, poultry, and dairy industries. The synthetic estrogen, diethylstilbestrol (DES), affects male fertility. For example, DES was prescribed from 1945 to 1971 to millions of women during pregnancy. Male offspring from those women had a higher incidence of developmental problems of the reproductive tract, as well as diminished sperm volume and sperm count. Exogenous estrogens impact fetal development by inhibiting the development of Sertoli cells, which determine the lifelong capacity for sperm production. Circulating estrogens also inhibit enzymes involved in testosterone synthesis and may directly affect testosterone production.

Omega-3: A study with two hundred thirty-eight infertile men with idiopathic oligoasthenoteratospermia investigated the effect of omega-3 on fertility. A 32 weeks treatment has shown significant improvement of sperm cell total count and sperm cell concentration in the omega-3 group suggesting the benefit of omega 3 on male fertility.

Zinc: Zinc is essential for normal functioning of the male reproductive system. Enough zinc intake ensures proper sperm motility and production. Zinc deficiency is associated with decreased testosterone levels and sperm count. There was a trend observed for a lower Zn levels in seminal plasma of smokers compared with nonsmokers. Seminal Zn in fertile and infertile (smokers or nonsmokers) males correlated significantly with sperm count and normal morphology of sperm. Poor Zn nutrition may be an important risk factor for low quality of sperm and idiopathic male infertility. Zinc levels are generally lower in infertile men with diminished sperm count. Studies have found supplemental zinc may prove helpful in treating male infertility. Some studies have suggested that male patients with infertility given zinc treatment significantly increased testosterone levels and sperm count, sperm motility and normal sperm morphology.

Vitamin C: Lower levels of vitamin C may lead to infertility and increased damage to the sperm’s genetic material. Study has suggested that reducing vitamin C intake in healthy men increased sperm DNA damage.

Vitamin E: Vitamin E is an antioxidant and has been shown to inhibit freeradical-induced damage to sensitive cell membranes. It improved sperm motility and improved sperm function in the zona binding assay, therefore enhancing the ability of the sperm to penetrate the egg in vitro.

Glutathione/Selenium: Glutathione and selenium are essential to the formation of an enzyme present in spermatids which becomes a structural protein in mature sperm. Deficiency of these two could damage sperm motility.

Coenzyme Q-10: Recent data from patients with idiopathic asthenozoospermia has shown that CoQ10 improves sperm counts and motility.

Vitamin B12: Deficiency of Vitamin B12 has been associated with decreased sperm count and motility.

Keep scrotum cool, if you want to get pregnant

Sperm is produced in testis located in scrotum attached to the body. In this place testis could be kept in low temperature( a few degrees lower than body temperature) which is required for sperm production. This is vital for sperm production in male. If anything elevates the temperature, it could damage sperm production.

If you want to get pregnant, you need to keep the scrotum cool. The question is how? There are some approaches you could take:

1, Wear a loose underwear to keep scrotum away from your body to avoid body heat.

2, Keep laptop away from your thigh to avoid heating up scrotum.

3, Stop riding bycycles to avoid heating up scrotum.

4, Treat varicocele veins to speed up blood circulation to maintain low temperature.

5, Lose weight to reduce excessive fat which warms up testis.

6, Acupuncture can relax scrotal muscles and improve blood circulation to keep temperature down.

Exercises affect sperm count

Physical activity has benefits for human’s general health however its association with male fertility remains unclear. Some researchers have proposed strenuous exercise as a risk factor for male factor infertility because it has been seen there was a reduced semen quality in long-distance runners and endurance cyclists. A recent research from Harvard School of Public Health studied if paternal physical activity associated with semen quality parameters and with outcomes of infertility treatment. In this study, most physical activity was moderate and heavy outdoor activities (38%), followed by running and jogging (24%), weightlifting (16%), bicycling (16%), swimming laps (3%), playing tennis or squash (2%) and aerobics (1%). They found that higher sperm count is related to higher levels of moderate to vigorous physical activity while sperm motility (total and progressive) and morphology were not related to physical activity. They also studied whether specific physical activities were associated with sperm concentration. Men in the highest category of outdoor activity (≥1.5 h/week) and weightlifting (≥2 h/week) had higher sperm concentrations than men with 0 h/week. Bicycling, in contrast, was inversely associated with sperm concentrations. Men who reported bicycling ≥1.5 h/week had lower sperm concentration compared with men who reported no bicycling. Time spent walking, running, jogging or in other specific physical or sedentary activities was not associated with sperm concentration. They also studied the relationship of paternal physical and sedentary activities with outcomes of infertility treatment. They did not find an association between time spent in moderate-to-vigorous or sedentary activities and clinical pregnancy or live birth rates following IUI or ART.

Some modern techniques might decrease your sperm quality

Exposure to radiation, both ionizing and nonionizing, has been shown to be a hormone disruptor. People may not realize that when you are using modern techniques, you are exposed to radiation significantly. Study on cell line has shown that exposure to mobile phone radiation altered gene and protein expression in cell lines. In a recent study, patients who used a cell phone showed significantly higher free testosterone and lower LH levels than those who did not, and sperm quality was negatively affected. A review has suggested that the use of mobile phones may decrease sperm concentration, motility (particularly rapid progressive motility), normal morphology, and viability. The abnormalities seemed to be directly related to the duration of mobile phone use. However, present evidence is inconclusive.

Effect of mobile telephones on sperm quality

Mobile phones produce radiation which may affect male fertility. Another study has shown that donor normozoospermic samples, which were exposed for four hours to a wireless internetconnected laptop showed a significant decrease in progressive sperm motility and an increase in sperm DNA fragmentation. The researchers advised against locating a laptop near the testes. There was a study from the UK has investigated that the effect of mobile phones on sperm quality. In this study, the participants were 1492 from fertility clinic and research centers. There were ten studies included. The findings were exposure to mobile phones was associated with reduced sperm motility and viability. The results from in vitro and in vivo studies suggest that mobile phone exposure negatively affects sperm quality.

Get sperm quality improved before IVF/ICSI

In about 50% of cases, male factors play a role in a couple's infertility. Medical science still has problems determining when and whether a sperm problem is the primary or contributing cause for problems with fertility. Lifestyle, environmental, and psychological factors may affect sperm quantity and quality. A recent study involved in 3106 couples showed that high-level sperm DNA fragmentation has a detrimental effect on outcome of IVF/ICSI, with decreased pregnancy rate and increased miscarriage rate. This study indicated that high sperm DNA damage was related to lower pregnancy rates in IVF but not in ICSI cycles, whereas it was associated with higher miscarriage rates in both IVF and ICSI cycles. It is suggested that before clinical high tech clinical treatments start, changes in lifestyle and environmental and psychological factors in male would improve male fertility, such as stop smoking, stop drinking alcohol, avoiding hot bath and cycling, reducing stress, losing weight et al. Acupuncture can help with improving sperm quantity and quality and reducing stress.

Chronic prostatitis and male infertility

Chronic prostatitis is a very common disease in the male genitourinary system. Some research has shown that chronic prostatitis was linked to male fertility. It was reported that chronic prostatitis was associated reduced sperm production and impairment of semen quality and sperm morphology and motility. Also very recently it was found that men with prostatitis and varicocele had significantly higher DNA fragmentation compared with men in the control group. There was a negative impact of these diseases on the concentration and the percentage of motile sperm cells in the ejaculate. Prostate secretion meets sperm cells during ejaculation and the sperm damage could occur in the short time during ejaculation. Or a direct effect of inflammation on the testis and epididymis could contribute to the damage.

Does prostate abnormality induce antisperm antibody?

There are three major prostate abnormalities namely, prostatitis, benign prostatic hyperplasia (BPH) and prostate cancer. . In all these abnormalities, infection/inflammation has been involved. As infection/inflammation of the male genital tract can also be involved in production of antisperm antibodies (ASA), Does prostate abnormality induce ASA. There was a study with healthy man and man with prostatis, BPH and prostate cance. They found that chronic prostatitis, BPH and prostate cancer do not induce antibodies to spermatozoa, sperm-specific antigens and seminal plasma components.

Acupuncture can help with prostatitis by improving the local blood flow and reducing inflammation. As a result, it could improve the fertility.

References
Adams JA et al Environ Int (2014) 70:106-12
Jensen TK et al Am. J. Epidemiol. (2009) 170:559-565.
Daniel M Campagne Int J Fertil Steril (2013) 6:214-223
Safarinejad MR Andrologia (2011) 43:38-47
Balercia G J Endocrinol Invest (2009) 32:626-32
Colagar AH et al Nutr Res (2009) 29:82-8
Gaskins AJ et al Hum Reprod (2014) Aug 27
Zhao J et al Fertil Steril (2014) 102:998-1005
Osadchuk LV et al Urologiia (2014 3:37-43
Hoover and Naz Int J Androl (2012) 35:608-15
Sinclair S Altern Med Rev (2000) 5:28-38


Wednesday, 10 September 2014

Acupuncture helps with osteoporosis

Bone density starts losing from about 35 years of age. Women lose bone rapidly in the first few years after the menopause. Losing bone is a normal part of the ageing process, but for some people it can lead to osteoporosis and an increased risk of fractures. Osteoporosis is a condition that weakens bones, making them fragile and more likely to break. This is a common condition that affects around three million people in the UK. More than 300,000 people receive hospital treatment for fragility fractures every year as a result of osteoporosis. The most common type of breaks that affect people with osteoporosis is wrist fracture, hip fracture and fracture in the bones in the spine. Osteoporosis is commonly no sign until a bone is fractured after a minor falls.

Do you know that acupuncture can help improving osteoporosis and increasing bone density? A research study has shown that 12 weeks acupuncture plus tuina regulate the lumbar biomechanical structure through the positive stress stimulation and reconstruct the mechanical equilibrium of the lumbar vertebra. This study suggested that acupuncture plays the active significance in the prevention and treatment of osteoporosis. Other studies have shown that the bone mineral density of lumbar vertebrae and femur in acupuncture treatment group increased obviously than that before treatment in men and in post menopausal women. The mechanism is that acupuncture increases circulation and improves bone mineral density.

References
Wang et al Zhongguo Zhen Jiu (2012) 32:685-8
Qu-Yang G et al Zhongguo Zhen Jiu (2011) 31:23-5
Qu-Yang G et al J Tradit Chin Med (2002) 22:9-11

Friday, 22 August 2014

Acupuncture can help with thigh pain

Thigh pain is a very common complaint. It presents constant aching, or throbbing pain sometimes cramping in the thighs or it could be on and off, but the pain does not go away. It could be one thigh or both thighs. This pain could radiate down to the knees, legs and feet or up to the hips. The pain can be felt when sitting and lying down. It could cause trouble walking long distance. Thigh pain comes up or becomes worse after running.

The pain on the outside of your hip, upper thigh, outer buttock or outside of knee is usually caused by problems with muscles, ligaments, tendons and other soft tissues. The iliotibial band inflammation is one of the common causes of thigh pain. The iliotibial band is a band of fibrous tissue that runs down the outside of the thigh. It provides stability to the knee and hip and helps prevent dislocation of those joints. The band may tighten and rub across the hipbone or the outer part of the knee. Each time the knee is bent or the hip flexed, the band rubs against bone. This is particularly common in runners, cyclists, and people who participate in other aerobic activities. Also the inflammation stimulates muscle contracting and this contributing to the pain. Acupuncture is very effective to reduce the inflammation and relax the muscles to release the pain.

There are other common causes of hip pain caused by soft tissue injury in the hip and acupuncture is a very effective treatment.

Hip bursitis or Trochanteric bursitis, pain is on the outside of the hip that is worse during activity and tenderness is in the area on the outside of the hip when pressing in.

Hip synovitis symptoms include pain in the hip joint during activity, at rest and at night.

Piriformis syndrome causes buttock pain that radiates down the leg.

Snapping hip, a hip pain with a snapping noise is heard or felt on the outer hip. Pain is not always present but can be felt at the front of the hip or side of the hip.

Hip tendonitis is inflammation of any one of a number of tendons in the hip. Pain develops gradually over time with tenderness around the hip.

Iliopsoas bursitis symptoms include pain at the front of the hip that may radiate down to the knee or even into the buttocks. Iliopsoas inflammation is the muscle or tendon becoming inflamed. It causes pain in the groin.

Thursday, 21 August 2014

Acupuncture can help with plantar fasciitis (heel pain)

Heel pain is very common. The pain is in intense when using the affected heel and placing weight on the heel. Heel pain usually comes up gradually and gets worse over time. The pain is usually worse first thing in the morning, or when you first take a step after a period of inactivity. Walking usually improves the pain, but it often gets worse again after walking or standing for a long time. Some people may limp when they try to avoid placing weight on the affected heel. Most common condition causing heel pain is the plantar fasciitis I which the plantar fascia, a band of tissue under the sole of the foot becomes damaged and thickens. Sudden damage, or damage that occurs over many months or years, can cause tiny tears to develop inside the tissue of the plantar fascia. This can cause the plantar fascia to thicken, resulting in heel pain.

Plantar fasciitis is the most common injury of the plantar fascia and is the most common cause of heel pain. Plantar fasciitis can be painful. The pain of plantar fasciitis has unique characteristics -- pain upon rising, improvement after walking for several minutes, pain produced by pressure applied in a specific location on your foot but not with pressure in other areas. It is associated with long standing. The main symptom is sharp heel pain which is worsen by bearing weight on the heel after long periods of rest for example after getting out of bed or after prolonged periods of sitting. After continuing walk, the pain symptoms is improved. There may be other symptoms accompanied the pain such as numbnesss, tingling, swelling or radiating pain.

Acupuncture can be used to treat heel pain effectively. Some high quality studies report significant benefits of acupuncture. Acupuncture was associated with significant improvement in pain and function.

A study investigated effectiveness of acupuncture for patients with chronic plantar fasciitis. Acupuncture coupled with conventional treatments provided a success rate of 80% in chronic planar fasciitis which was more effective than conventional treatments alone (13%). The effects lasted for at least six weeks follow-up.

There are some other clinical evidences by recent research on this aspect. There is a study which investigated the efficacy of electro-acupuncture coupled with conventional treatments and compared it with the efficacy of conventional treatments alone in patients with chronic plantar fasciitis. Subjects in the control group received five weeks of conventional treatments, including stretching exercise, shoe modification and rescue analgesics. Subjects in the acupuncture group received the same treatments plus ten sessions of electro-acupuncture twice weekly. At the end of treatment, pain score decreased significantly in the acupuncture group compared with and control group. At the sixth week follow-up, subjects in the acupuncture group showed a better foot function index and success rate for pain during the day than those in the control group. Electro-acupuncture coupled with conventional treatments provided a success rate of 80% in chronic planar fasciitis which was more effective than conventional treatments alone. The effects lasted for at least six weeks. Another study also compared the effect of acupuncture with that of conventional treatment including treatment with ice, non-steroidal anti-inflammatory medication, and a stretching and a strengthening program. They also found acupuncture had better effects than those conventional treatment and they suggested that acupuncture should be considered as a major therapeutic instrument for the decrease of heel pain, combined with traditional medical approaches.There was a study compared effect of miniscalpel-needle (MSN) ( a special type of acupuncture) with steroid injection for the treatment for plantar fasciitis. Their results showed that visual analog scale scores for morning pain, active pain, and overall heel pain all were decreased significantly in the MSN group from 1 to 12 months after treatment. In contrast, treatment with steroid injection showed a significant effect only at the 1-month follow-up but not at 6 or 12 months after treatment. Moreover, the MSN group achieved more rapid and sustained improvements than the steroid group throughout the duration of this study. No severe side effects were observed with MSN treatment. Their data suggest that the MSN release treatment is safe and has a significant benefit for plantar fasciitis compared to steroid injection.

Reference
Clark & Tighe Acupunct Med (2012) 30:298-306
Kumnerddee and Pattapong Am J Chin Med (2012) 40:1167-76
Kemnerddee W and Pattapong N Am J Chin Med (2012) 40:1167-76
Karagounis et al PFoot Ankle Spec (2011) 4:226-34
Li S et al Evid Based Complement Alternat Med (2014) 2014:164714

Wednesday, 6 August 2014

Acupuncture in Peking University

Peking University was founded in 1898. Originally known as the Imperial University of Peking, it was the first national university covering comprehensive disciplines in China, and has been a leading institution of higher education in China since its establishment. It also served as the highest administration for education at the beginning of its founding.

In 2000 Beijing Medical University which becomes Peking University Health Science Center (PUHSC) was merged with Peking University.

PUHSC has built a unique campus culture that advocates diligence, rigor, objectivity and creativity. And the faculty and graduates of PUHSC are known for their devotion to the country and to the health profession. Its highest goal is to create an internationally recognized medical institute of excellence and to offer first-class medical education for the health of all human beings.

Acupuncture in PUHSC.

On March 27th 2014, the award ceremony of The Second Cheung On Tak International Award for Outstanding Contribution to Chinese Medicine was held in Hong Kong Baptist University. Professor Han Jisheng, member of Chinese Academy of Sciences in Peking University was presented with this honor.

As the winner of the award this year, Professor Han Jisheng attended the ceremony and delivered a speech on his research and experience in acupuncture. He has been devoted to this field for decades since 1965 and made great progress capturing worldwide attention. In his speech, Professor Han also reviewed the national policy on integrative Chinese and western medical study of acupuncture. Besides, he envisioned the application of acupuncture and put forward his advice to promote the therapy worldwide. He expressed his gratitude to the cooperative colleagues and students in Neurosciences Institute of Health Science Center, Peking University.

Since 1965 Professor Han Jisheng started his research on acupuncture mechamisms especially its analgesic effects. His devotion to explore the neurochemical basis of acupuncture analgesia has resulted in findings that have deservingly received worldwide recognition. Professor Han became the first to discover the spatio-temporal character of the analgesic effect triggered by acupuncture at a certain point by systemic observation in healthy human body. He put great efforts on putting forward pain research leading to recognition of acupuncture therapy as an applicable methods in many countries. In 1997, the US National Institute of Health (NIH) invited Professor Han to give a lecture on the Consensus Conference on Acupuncture sponsored by NIH. Based on his and others’ data presented, NIH Consensus Conference confirmed the effectiveness of acupuncture for pain treatment and acknowledged its great potential for future development. The Austrian Acupuncture Society also expressed their appreciation to Professor Han for his research and works that led the Austrian government to accept acupuncture as an official pain therapy.

References
Albert Cheung Hoi Yu Neurochem Res (2008) 33:1911–1914
http://english.pku.edu.cn/News_Events/News/Focus/11205.htm

Thursday, 31 July 2014

Why live with pain? acupuncture helps to have pain free.

Acupuncture is an effective treatment for chronic pain conditions

Acupuncture is called ancient art and has been used in Asia for centuries to treat many conditions and relieve pain. It is now being recognised in western countries, such as USA and European countries. It is used to ease back pain, nerve pain and other pain conditions.

If a pain last over 3 month, it is chronic. Chronic pain is a common condition. It can occur in many places such as low back pain, neck pain, headache, migraine and knee pain. Chronic pain in the muscles and joints can make life miserable. Many simple treatments like ice and heat, anti-inflammatory medications, physical therapy, and appropriate exercises can often ease the pain. If these methods don’t work, not everyone is able or willing to take pain medication every day, and not everyone can or should have surgery for painful conditions.

Chronic pain is very common and difficult to manage. Apart from pain killers, acupuncture is well accepted to treat chronic pain conditions. Complementary and alternative medicine (CAM) plays an important role to reduce pain and improve quality of life for those who suffer from chronic pain. A survey by MG Tan et al from Singapore studied the use of CAM in chronic pain patients in Singapore. They found that 84% of patients used CAM at some point of their life. 30% of patients used CAM for other reasons instead of chronic pain. 35% of patients used for both pain and non pain conditions. Acupuncture was the most utilised which is 49%, followed by Chinese herbs (18%), Tui Na (17%) and massage (16%). Many patients were on more than one form of the CAM. 72% patients thought that CAM helped with their pain. 26% patients used CAM because conventional medicine did not work. 38% thought it was safer and had fewer side effects. 24% of patients thought it was cheaper. 85% of patients were satisfied. Many patients did not discuss the use of CAM with their doctor, mainly because they thought that CAM is more natural and safe.

Acupuncture has little side effects and well tolerated. A survey from people accepted acupuncture treatment has shown that 46% said acupuncture helped greatly, 26% said it helped in some degree and 28% said there was little help. Research showed that lower back pain is the most common reason for visiting acupuncturists. Usage of acupuncture has increased enormously in recent 10 years.

Recently, Mao et al reviewed clinical research of a few chronic pain condition treatments with acupuncture including lower back pain, knee pain, neck pain and headache. Low back pain is the most common reason for visits to acupuncturists. Recent 10 years, using high quality randomized controlled trials study acupuncture has increased enormously. Most of them have shown that acupuncture treatment is effective to lower back pain and it is better than no treatment or equivalent to other conventional treatments. The situation of knee pain with acupuncture treatment is pretty similar to lower back pain which is acupuncture is better than no treatment. For neck pain treatment with acupuncture some controlled trials suggested that acupuncture is better than or equivalent to physiotherapy. Some study suggested that acupuncture is better than massage and dry needling in motion-related neck pain. In a study on headache, it showed that acupuncture reduced headache frequency and severity, and at the same time it also improves headache related quality of life. There is a review about acupuncture for chronic pain by Vickers AJ et al just published in Arch Intern Med (2012). They analysed 29 clinical randomized controlled trials involving in 17922 patients to investigate the effect of acupuncture for 4 chronic pain conditions: back and neck pain, osteoarthritis, chronic headache and shoulder pain. In the primary analysis, including all eligible trials, acupuncture was superior for both sham and no acupuncture control for each pain condition. After exclusion of an outlying set of trials that strongly favoured acupuncture, the effect sizes were similar across pain conditions analysed. Patients receiving acupuncture had less pain. They concluded that acupuncture is effective for the treatment of chronic pain and it is more than a placebo. Acupuncture is clearly a treatment option.

It becomes general knowledge that acupuncture releases pain effectively. However the effectiveness of acupuncture for pain relief is still coming up for debate and there are always some clinical trials showing lack of effect compared with control. What is the reason for this? Macpherson et al analysed clinical trials involving patients with headache and migraine, osteoarthritis, and back, neck and shoulder pain. There were many different types of controls used in the trials including sham controls such as non-needle sham, penetrating sham needles and non-penetrating sham needles and non sham control such as non-specified routine care and protocol-guided care. They analysed the impact of choice of control on effect of acupuncture. They found that acupuncture was significantly superior to all categories of control group. For trials that used penetrating needles for sham control, acupuncture had smaller effect sizes than for trials with non-penetrating sham or sham control without needles. Large effects of acupuncture were seen after exclusion of outlying studies. In trials with non-sham controls, larger effect sizes associated with acupuncture vs. non-specified routine care than vs. protocol-guided care. From this study it can be seen that acupuncture is significantly superior to control irrespective of the subtype of control. Penetrating needles can have positive effects which should be avoided as a control in the study.

Recently a study analysed 29 clinical trials involved in 17922 patients with chronic pain treated with acupuncture. This study suggested that acupuncture is effective for the treatment of chronic pain including back and neck pain, osteoarthritis, and chronic headache and acupuncture is a reasonable option. There is scientific evidence how acupuncture works. Many research suggested that acupuncture relives pain by affecting neurotransmitters, hormone levels, or the immune system.

What is important when using acupuncture to treat chronic pain

Many researches with huge sample sizes showed that acupuncture is effective to treat chronic pain. Acupuncture is not a standardized treatment method. If you see different acupuncturists, you would receive acupuncture with different characteristics for sure. There are different styles of acupuncture, Chinese acupuncture, Western acupuncture or mixed Chinese and Western acupuncture, which are based on different theories. Even for the same style of acupuncture, the duration and frequency of the treatments could be different performed by different acupuncturists. The points used could be different as well. Additional usage of electrostimulation or electroacupuncture, moxibustion or manipulation could be applied by some acupuncturists.

From research point of view, there is a great variation of acupuncture characteristics. MacPherson et al analysed the research trials for acupuncture effect on chronic pain. Majority of research trials (59%) was based on traditional Chinese acupuncture and majority of points (55%) selected were flexible. Most of the research trials are manually stimulated and only a few trials used electrical stimulation and a few trials added with moxibustion. Attempts to obtain de qi sensation were made in all 25 trials which provided this information. The maxium number of sessions varied broadly from 3 to 30 and duration of sessions also varied from 15-32 minutes. The needles or points used were range from 1-18 points. The frequency of treatment was from one session every eight days to two sessions a week.

Their results showed that when comparing acupuncture with sham acupuncture controls, there was little evidence that the effects of acupuncture on pain were modified by any of the acupuncture characteristics evaluated, including style of acupuncture, number or placement of needles, the number, frequency or duration of sessions, patient-practitioner interactions and experience of the acupuncturist. When comparing acupuncture to non-acupuncture controls, better pain outcomes were obtained when more needles were used and also when a higher number of acupuncture treatment sessions were provided. They conclude that there was little evidence that different characteristics of acupuncture or acupuncturists modified the effect of treatment on pain outcomes. Increased number of needles and more sessions are associated with better outcomes when comparing acupuncture to non acupuncture controls. They suggested that dose is the key factor.

There was a report that investigated the outcomes of acupuncture for chronic pain in urban primary care from New York. Patients selected for the acupuncture treatment were over 21 years old with chronic pain caused by osteoarthritis or neck or back pain. Acupuncture was provided by supervised acupuncture students for up to 14 weeks. Pain and function were evaluated before during and after acupuncture treatment. They found that back pain was the most common referring diagnosis 59.5% followed by osteoarthritis 16.3%. Pain severity and function significantly improved at 12 and 24 weeks after baseline assessment. They concluded that weekly acupuncture improved pain severity and quality of life.

Why can acupuncture be used to relive pain?

Acupuncture can act as a pain killer and it is used in many conditions and helps relieve pain. The mechanism is studied by modern research. Studies have shown that pressure pain threshold is increased after acupuncture treatment. The effect could be long-term and short-term. Studies have also shown that acupuncture reduced sensitivity to noxious thermal stimuli which could be mechanical (such as pinching or tissue deformation), chemical (such as exposure to acid or ittitant) or thermal (such as high or low temperature). Sensory threshold changes were equally frequent reported after manual acupuncture as after electroacupuncture. Acupuncture affects sensory perception. Results are most convincing for the pressure pain threshold, especially in pain conditions associated with tenderness.

Acupuncture is used for women with chronic pelvic pain

If you've had pelvic pain for six months or more that either comes and goes or is continuous, it is known as chronic pelvic pain (CPP). CPP is more intense than ordinary period pain and lasts for longer. It affects around one in six women. A research paper studied the prevalence of and factors associated with use of complementary health approaches mong women with CPP. The result has shown that slightly over one-half (51%) of women with CPP used at least one complementary health approach in the past year, including acupuncture (8%), special foods or diets (22%), herbs (27%), and vitamins and minerals (29%). During follow-up surveys conducted annually for 4 years, a substantial proportion of women (44.8%) used complementary health approaches at more than half of the assessments. Users of complementary health approaches were more likely to undergo a hysterectomy or oophorectomy or to use gonadotropin-releasing hormone agonists or opioids during the study compared with nonusers. Women with CPP who used complementary health approaches also had more optimal health-related quality of life measured by the Pelvic Problem Impact Questionnaire.

Acupuncture is the best option for depression with pain problems

Up to about 70% patients with depression also have pain problems. Depression may make the pain problem worse and more pain may make depression worse as well. The existing research data has shown that acupuncture is an effective treatment option for several chronic pain conditions. Acupuncture is also suggested to treat depression, though this is not available option in NHS. Counselling for depression is widely available in primary care practices, however there is limited evidence for counselling compared to usual care as a treatment for patients with depression and a chronic physical health problem. Recently a report compared acupuncture or counselling with usual care alone for 755 patients with depression complicated with pain. They found that at 3 months, both acupuncture and counselling interventions were effective for depression compared to usual care alone whether there was pain or not. Patients in the pain group had greater reductions in both depression symptoms with acupuncture from baseline to 3 months than those who received counselling or usual care. All treatment options were effective in reducing pain between baseline and 3-month follow-up after controlling for baseline pain, however, acupuncture delivered a greater degree of pain relief than counselling or usual care in the short-to-medium term. Reductions in both depression and pain were most marked in the acupuncture group, followed by the counselling group and then the usual care group.

Acupuncture is effective for muscle pain

Muscle pains are common and can involve more than one muscle. Muscle pain also can involve ligaments, tendons, and fascia, the soft tissues that connect muscles, bones, and organs. Muscle pain is most frequently related to tension, overuse, or muscle injury from exercise or physically-demanding work. In these situations, the pain tends to involve specific muscles and starts during or just after the activity. It is usually obvious which activity is causing the pain. Trapezius muscle is a large superficial muscle that extends longitudinally from the skull to the upper back and laterally to the shoulder blade. Its functions are to move the scapulae and support the arms. These muscles are usually overused and painful due to much stress and improper postures.

Acupuncture is a useful tool to release trapezius muscle pain. There were 20 women aged ranging from 18 to 40 years with upper trapezius muscle pain for average 5.55 years. They were treated with acupuncture After 9 sessions of acupuncture treatments, a reduction in pain intensity was observed on the upper trapezius muscle on both sides. The Pain pressure threshold increased significantly on both sides at the end of the treatment. A significant increase in the electromyography values of the trapezius during isometric contraction was observed at the end of treatment.

Acupuncture for myofascial pain

Myofascial pain syndrome (MPS) refers to pain and inflammation in the body’s soft tissues. This is a chronic condition that affects the fascia which is connective tissue that covers the muscles. Myofascial pain syndrome may involve either a single muscle or a muscle group. The person experiences pain either in the area where the pain originated or in other area where is far from the pain originated. Myofascial pain is mainly caused by injury such as injury to the muscles, excessive strain on a particular muscle or muscle group, ligament or tendon, or injury to muscle fibers. Other causes include repetitive motions or lack of activity. The symptoms of myofascial pain include pain with tender points. The pain can be worse with activity or stress. Pharmacological therapies include anti-inflammatory drugs, antidepressants, and muscle relaxants. Acupuncture can help reduce pain and inflammation to treat myofascial pain. Acupuncture has been widely used for acute or chronic pain management.

Why can acupuncture treat myofascial pain?

In TCM theory, the entire human body is composed of sophisticated interconnected inner systems, which there is an “energy (Qi)” that flows through “meridian (or channels)” in each organ. When the flow of Qi is blocked, pain occurs. By inserting and appropriate manipulating a needle into some points, the channel could be unblocked, thereby reestablishing the free and normal flow of Qi and relieving the pain. Most acupoints are located along one of these channels (some are exceptional).

Recent research has shown that acupuncture has analgesic effect. Acupuncture at one hand acupoint induced a gradual increase in skin pain threshold. Acupuncture induces endogenous opiates release from the pituitary gland into plasma and cause analgesia in the central nerve system. Acupuncture releases neuropeptides inhibiting the primary sensory neurons in the spinal cord. These substances also help reducing inflammation and reducing inflammation response.

Acupuncture is for chronic musculoskeletal pain, which acupuncture points are more effective?

Chronic musculoskeletal pain (CMP) is very common which happens to one in four people. More and more people used acupuncture for pain relief for CMP. If you do choose acupuncture, you need to know that there is diverse usage of acupuncture points for pain relief. Commonly, a combination of local and distant points is used. However, the difference between the effects of local and distant point stimulation is not clear. Recently a review investigated this subject. They studied a difference in effects between stimulating local and distant points, and the combination of both when compared with either alone. Nineteen were included in the qualitative analysis and 15 in the meta-analysis. Local and distant point stimulation was more effective than their respective controls in pain reduction immediately after treatment. Three studies directly compared the stimulation of local and distant points and found no significant difference between the two. No studies compared combined local and distant point stimulation with either alone. Subgroup analyses showed that, local tender point stimulation was more effective than local acupuncture points. Local and distant point stimulation induces similar degree of acupuncture analgesia. The benefit of combining local and distant point stimulation is unknown. However, subgroup analyses suggested that local tender points could be important in the treatment of CMP for short-term pain relief.

Acupuncture can help with fibromyalgia

Fibromyalgia syndrome is a rheumatic disorder characterized by chronic, diffuse and widespread musculoskeletal pain, and its cause is still not clear. Fibromyalgia is a long term condition which causes pain all over the body. In addition to widespread pain, there are other symptoms present including debilitating fatigue, sleep disturbance, jointstiffness, headaches and irritable bowel syndrome. People with fibromyalgia have often had depression and anxiety. The cause for fibromyalgia is unknown, but is believed involving psychological, genetic, neurobiological and environmental factors. In fibromyalgia, pain processing and neurotransmitter releasing in the brain are altered leading to lower pain thresholds. Fibromyalgia affects up to 4% of population. The main aims of therapy for this condition are to reduce symptoms and improve function. Painkillers, antidepressants and antiepileptics are commonly used. As fibromyalgia has a variety of symptoms, no single treatment will work for all of them. You need to find a treatment that suits you. Acupuncture is recommended as an effective option for reducing the pain sensitivity and improving quality of life. There are some evidences emerging showing that acupuncture is a useful treatment option for patients with fibromyalgia and acupuncture may have a great benefit when applied together with medication or other therapeutic options. More recently, Iannuccelli C et al showed that acupuncture could not only control pain but also improve associated symptoms and quality of life. There was a report about the effectiveness of acupuncture on patients with fibromyalgia. These eight women with fibromyalgia received a course of 2 months acupuncture treatments. After the course of acupuncture treatments there was a reduction in the pain threshold and sensitivity and improvement in the of anxiety and depression and quality of life.

How does acupuncture work? Acupuncture stimulates nerve endings leading to releasing endorphins and other neurohumornal factors and changing the processing of pain in the brain and spinal cord; acupuncture reduces inflammation by increasing production of vascular and immunomodulatory factors; acupuncture improves muscle stiffness and joint mobility by increasing local microcirculation.

References
Hopton A BMJ Open (2014) 4:e004964
Macpherson H et al PLoS One (2014) 9:E93739
Tan MG et al Ann Acad Med Singapore (2013) 42:133-7
Vikers AJ et al Arch Intern Med (2012) 10:1-10
Mao et al Prim Care (2010) 37:105-117
MacPherson et al PLOS ONE (2013) 8:e77438
J Am Board Fam Med (2013) 26:692-700
Aranha et al Rev Bras Fisioter (2011) 15:371-9
Chou LW et al Evid Based Complement Alternat Med (2012) 2012:705327
Wong Lit Wan D et al Eur J Pain (2015) Feb 17. doi: 10.1002/ejp.671. [Epub ahead of print]
Bastos JL et al J Acupunct Meridian Stud (2013) 6:163-8
Iannuccelli C et al Clin Exp Rheumatol (2012) 30:112-6
http://archinte.jamanetwork.com/article.aspx?articleid=1357513
Baeumler PI et al PLoS One (2014) 9:e113731

Thursday, 24 July 2014

Acupuncture for Multiple Sclerosis (MS)

Multiple Sclerosis (MS) is a degenerated central (brain and spinal cord) nervous system disorder. The insulating nerve cover in the brain and spine is targeted and damaged by the immune system. This results in loss of function of the nervous system causing various symptoms depending which nerves are affected most. There are 2.3 milion people worldwide suffer MS. Medical management limits the frequency and intensity of disease activity, but only for persons with relapsing-remitting MS. The most common type of MS is relapsing-remitting (RR) MS. In this type, s series of attacks followed by complete or partial disappearance of the symptoms until another attack occurs. It may be weeks to years between the attacks. The symptoms can be from mild to severe. Vision disturbances could be the first sign of MS. Limb weakness with or without difficulty of coordination and balance could be early symptom. Other common symptoms include muscle spasm, fatigue, numbness and pricking pain. Loss of sensation, speech impediment, tremors or dizziness can exist. Mental changes include lack of concentration and attention, memory loss, impaired judgment and performing sequential tasks, depression etc. Sexual dysfunction and reduced bowl and bladder control can develop as the disease worsens. Early treatments are recommended for patients with MS. Apart from medications, patients with MS are seeking complementary and alternative medicine (CAM) as an additional treatment option.

Acupuncture has been used in the management of neurologic conditions such as stroke, spinal cord injury, and Parkinson's disease. Acupuncture is also used in treating MS. There are also some studies on the effect of acupuncture on MS. This study is involved in a few aspects such as MS quality of life, MS fatigue, MS spasticity and MS pain.

For example, there is a case report of a sixty-five-year-old male with a twenty-year history of MS. The patient was received with Chinese scalp acupuncture once a week for ten weeks, then once a month for six more sessions. There was significant improvement in well-being, gait, balance, spasms, and incontinence. Another study has shown that after electroacupuncture of 10 weeks on nine MS patients with bladder dysfunction, mean urge frequency decreased significantly and mean number of daytime leaking episodes decreased. A study by McGuire examined the effect of acupuncture on the fatigue of a fifty-year-old female with MS who received twenty minutes of acupuncture once a week for seven weeks. There were reports of improvement on fatigue. Another study on twenty MS patients received twelve sessions of acupuncture over two months following an unsuccessful trial of the antifatigue medication Amantadine. Five of the twenty patients recorded improved scores on the FSS. Also there was a report that acupuncture improved coordination and fewer slips and trips with effects lasting for eight months in MS patient.

A study evaluated the efficacy of acupuncture in treating forty-nine MS patients with chronic pain using a case series pretest/posttest design. Patients received biweekly acupuncture treatments for six months and noticed significant improvements in the Oswestry Disability Index (ODI).

From these studies we can see acupuncture is a potential treatment option for MS patients, though much of the research needed for the efficacy of acupuncture.

There was a report by Kerr Grieve et al from Tayside MS research unit, Ninewells hospital and medical school, Dundee, Scotland. They had positive data to support that acupuncture is an effective treatment for pain and other MS symptoms. There were 20 patients with MS involved in the research. 85% were female aged 20 to 60 years. Duration of diagnosis was 1-29 years. All of the patients had been attending the clinic for between 3 and 24 months. The majority were receiving acupuncture on six weekly bases. 18 patients had some reduction in pain. 9 patients scored the level of pain relief as 8/10 or better. 18 patients had pain relief for four or more weeks. Improvement of sleep pattern, mood, energy levels and mobility was also subjectively improved, though not as much as pain relief. 9 patients had a temporary increase in pain. 55% of patientsreduced their use of pain killers and 3 stopped additional pain killers completely. The authors were confident that acupuncture could be a treatment for apin and other MS related symptoms for patients with MS.

Recently a survey conducted by Stoll SS et al from Neurology department in Drexel University College of Medicine Phyladelphia USA about using CAM treatment for patients with MS. 111 patients with MS completed the survey properly. All patients used non disease-modifying agents (non-DMA agents). 65 patients (58.6%) exercised on a weekly basis. 64 patients (57.7%) used CAM therapies such as acupuncture and massage, or osteopathic manipulative treatment and psychotherapy.

Quispe-Cabanillas JG et al investigated the effect of acupuncture in 31 patients with relapsing-remitting type of MS under treatment of immunomodulators. The patient’s quality of life was assessed to evaluate the effectiveness of acupuncture. They found that acupuncture improved various aspect of quality of life for those patients including reduction in pain and depression. Foroughipour M et al also observed the effectiveness of acupuncture in 20 patients with MS. They found that 12 sessions of acupuncture improved the fatigue symptom in patients with MS who were resistant to the medication amantadine.

References
Stoll SS et al J Am Osteopath Assoc (2012) 112:22-8
Quispe-Cabanillas JG et al BMC Complement Altern Med (2012) 12:209
Foroughipour M et al Acupunct Med (2012)
Kerr Grieve et al J Neurol Neurosurg Psychiatry (2013) 84:e2.
Karpakin HI et al Evid Based Completment Alternat Med (2014) 2014:972935

Wednesday, 2 July 2014

Varicocele and male infertility

Varicocele and male infertility

Infertility affects about 1 in 6 of the couples of reproductive age1. The male factor is involved in 40% - 50% of infertility cases. The most common type of male infertility is unexplained infertility, which is unknown cause. Another common cause of male infertility is varicocele which is enlarged veins in testicles. 78% - 93% of cases varicocele is located on the left side. The left internal spermatic vein inserts into the left renal vein at a right angle which leads to an increase in the hydrostatic pressure of the left spermatic vein causing its dilation. Also internal spermatic veins lack functional valves, which can lead to regression of blood. Possibly there is a partial obstruction of the left spermatic vein due to the compression of the left renal vein between the aorta and the upper mesenteric artery . Varicocele causes elevated temperature of the scrotum possibly due to reflux of warm blood from the abdominal cavity. High temperature causes thermal damage of the DNA and proteins in the nucleus of spermatic tubules' cells and / or Leydig cells. The increased vein pressure can influence testicular blood flow, cause accumulation of toxic metabolites which leads to chronic vasoconstriction and subsequent dysfunction of the spermatic epithelium. Men with varicocele have high FSH level and low sperm counts. Surgical repair of varicocele has been shown to restore the temperature in both animals and humans. However fertility potential is not always improved after surgical repair of varicocele though semen parameters were improved.

Oxidant stress and male infertility

Half of all cases of infertility have male factor involved. Oxidant stress damage to sperm is a significant contributing pathology in 30–80% of cases. What is oxidant stress? In cellular metabolism, there are free radicals produced and they can damage cells and also there are antixodants against this damage. If balance between free radicals and antioxidants is broken, oxidant stress occurs. If oxidant stress occurs in sperm, it reduces the sperm's motility and ability to fuse with the egg by damaging the sperm membrane and sperm DNA. This may cause male infertility. Oxidant stress is not screened nor treated. The possible causes of oxidant stress come from many sources such as life style including smoking, drinking alcohol, stress, environmental factors including heat, pollutions, infections, autoimmune problems, chronic disorders etc.

Management of oxidant related stress include: change life style, reduce exposure to toxic environment, treat infections and inflammations etc. Taking some supplements such as vitamine C, B complex, and E may help reducing oxidant stress. Acupuncture may help reduce oxidant stress by improving blood circulation and taking toxic free radicals away.

Sperm is impaired by inflammation and acupuncture can help

Semen quality is affected by prostate and genital tract inflammation. There was a study on 382 voluntary male subjects who underwent the screening for prostate health. Sperm motility and prostate-related parameters were significantly impaired in patients with chronic prostatitis syndromes and lower urinary tract symptoms in comparison with controls. Elevated seminal markers of inflammation were in positive association with body mass index, prostate-specific antigen, and estradiol level in serum while in negative association with semen volume, total sperm count, and sperm motility. It was suggested that one of the possible pathways for impaired reproductive quality in male subjects >45 years could be related to infection and inflammation in the genital tract with subsequent (partial) obstruction and damage of prostate and other male accessory glands. Previous study has shown that acupuncture could improve sperm parameter in men with genital tract inflammation.

What is ICSI?

ICSI stands for intracytoplasmic sperm injection. This procedure can be used in male factor infertility with low concentration of sperm, low sperm motility and low sperm morphology. This procedure involves that individual sperm is picked up manually and injected into the inner part of the egg. The egg is obtained through the same egg retrieval procedure as IVF. This usually results in normal fertilization in about 75-85% of eggs injected with sperm of course depending on the clinics.

Do you know acupuncture can help increase sperm counts and improve sperm motility in men with varicocele?

Acupuncture may help male fertility by lowering scrotal temperature, reducing inflammation, improving circulation and improving sperm maturation.

References
Tremellen K Hum Reprod Update (2008) 14:243-58
Kantartzi PD et al Hippokratia. (2007)11: 99–104.
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/male-infertility.html
Ausmees K et al World J Urol (2013) 31:1411-25
Siterman S et al Asian J Androl (2009) 11:200-8

Tuesday, 24 June 2014

Acupuncture helps improving foot drop

Foot drop, sometimes called drop foot is a muscular weakness or paralysis that makes it difficult to lift the front part of your foot and toes. This causes the toes to drag along the ground while walking. To avoid dragging the toes, people with foot drop may lift their knee higher than normal. Or they may swing their leg in a wide arc. Foot drop can happen to one foot or both feet at the same time. Foot drop is a symptom rather than a condition. The causes could be muscle disorders, nerve damage in the leg, or brain and/or spinal injury. Muscles disorders including muscular dystrophy, amyotrophic lateral sclerosis and polio cause the muscles to progressively weaken causing foot drop. Some conditions including sports injuries, diabetes, spending long hours sitting cross-legged or squatting, hip or knee replacement surgery, childbirth etc could cause peroneal nerve damage or compressed causing foot drop. Brain or spinal disorders including stroke, multiple sclerosis (MS) and cerebral palsy also can cause foot drop.

The treatments depend on the causes of the foot drop which include physiotherapy, wearing an ankle-foot orthosis, electrical nerve stimulation and surgery. Acupuncture was also reported to be useful to help improving foot drop.

References
Jagirdar PC Indian J Lepr (1986 58:618-22
Liu ZP et al Zhongguoe Zhen Jiu (2012) 32:293-6

Monday, 16 June 2014

Tailbone pain, acupuncture can help

Tailbone pain, acupuncture can help

The medical term of tailbone pain is coccydynia. It is caused by inflammation of tail bone area. It presents with pain and tenderness at the tip of the tailbone between the buttocks. The pain is often worsened by sitting. Tailbone pain is often caused by an injury, such as sitting for a long time or bike rides, but it may have unknown causes. Vaginal birth in women sometimes is the cause tailbone pain. The coccyx or pelvic bones injury is a risk factor and obesity is also a risk factor for getting tailbone pain. Secondary tailbone pain includes sciatica, infection such as shingles of the buttocks, pilonidal cysts, sacroiliitis, and fractured bone. The major symptoms are pain and local tenderness at the tailbone. This can lead to difficulty sitting or leaning against the buttocks. Along with the pain with sitting, there is typical tenderness at the tailbone area. Treatments include rest and sitting on a pillow, cushion, or buttock support; avoiding reinjury to the affected area, anti-inflammatory pain killers; cortisone injection; physical therapy with exercises and last not the least acupuncture.

Acupuncture reduces leg pain

Leg pain can be mild that comes and goes, or severe that makes it difficult to sleep and walk. The pain is often described as aching, throbbing or burning and it can be accompanied by numbness, tingling and muscle weakness. Leg pain can develop from leg injury, over exercise, tear or overuse. Problems that affect the blood vessels can also cause leg pain. These include peripheral arterial disorder, inflammation of a vein or blood clot etc. Another common cause of leg pain is the problem of low back where the nerve to the leg originates and then travels to the legs. For leg pain treatments, finding the cause is important and treatments depend on the causes. Acupuncture is used for the leg pain management.


References

Grgic V Lijec Viesn (2012) 134:49-55

Gataullin IG and Samitov Osh Khirurgiia (Mosk) (1989) 2:64-6

Sunday, 15 June 2014

Acupuncture for slipped disc and sciatic pain

Slipped disc treated with acupuncture

A slipped disc or prolapsed or herniated disc is a condition in which the disc in the spine is torn and the central part inside leaks out. It causes chronic back pain. The pain is often begins in the lower back and over time it spreads to other parts of the body. Sometime there is no symptom. This is because the slipped part of the disc is small which will not affect nerves or spinal cord. If sciatic nerve is affected the pain could travel from the back of the pelvis, through the buttocks and down the legs to the feet. It could be also accompanied with numbness, tingling sensation in legs. Muscle paralysis, muscle spasms and urinary incontinence are also common symptoms. If the nerves at the very bottom of the spinal cord become compressed, it causes cauda equina syndrome. The symptoms include lower back pain, numbness in the groin area, paralysis of one or both legs, rectal pain, bowel disturbance, inability to pass urine or incontinence and pain in the inside of the thighs. The interventions for slipped discs include acupuncture, advice to stay active, analgesics, antidepressants, bed rest, corticosteroids (epidural injections), cytokine inhibitors (infliximab), discectomy (automated percutaneous, laser, microdiscectomy, standard), exercise therapy, heat, ice, massage, muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), percutaneous disc decompression, spinal manipulation, and traction.

A recent study has shown that acupuncture had better effects than that of Fugui Gutong capsule and ibuprofen for slipped disc. The scores of clincial symptoms and therapeutic effect were observed before and after treatment. Results In the electroacupuncture group, the effective rate was 84.4% (38/45), which was superior to that of 65.0% (26/40) in the medication group. After treatment, the scores of symptoms significantly decreased in the two groups, and the reduction of scores in electroacupuncture group was superior to that in medication group.

Which acupuncture points are used to treat slipped discs? A study analysed data from recent 10 years. They found 49 main acupuncture points from 173 studies. there were 10 most common used acupoints on Bladder Meridian [Geshu (BL 17), Xiaochangshu (BL 27), Shenshu (BL 23), Dachangshu (BL 25), Pangguangshu (BL 28), Guanyuanshu (BL 26), Weizbong (BL 40), Zhibian (BL 54), Chengshan (BL 57), Kunlun (BL 60)], 2 on Gallbladder Meridian [Huantiao (GB 30), Yanglingquan (GB 34)], 2 on Governor Vessel [Yaoyangguan (GV 3), Shuigou (GV 26)], 2 on Stomach Meridian [Zusanli (ST 36), Juliao (ST 3)], 2 on Spleen Meridian [Sanyinjiao (SP 6), Xuehai (SP 10)], and the rest were extra points (Huatuo Jiaji) and Ashi points, so a conclusion could be drawn that the most common used acupoints were Bladder Meridian acupoints and supplemented by Gallbladder Meridian, Governor Vessel, Stomach Meridian, Spleen Meridian, extra points and Ashi points. The selected acupoints were most located on the lumbosacral region, leg and fewer located on the face, back and local part.

Acupuncture is effective for sciatic pain.

Sciatiic pain is pain caused by irritating sciatic nerve. Sciatic nerve is the longest nerve in the body and it runs from the back of your pelvis, through your buttocks, and all the way down both legs, ending at your feet. Sciatic pain can range from being mild to very painful and may last just a few days or for months. The pain of sciatica radiates out from the lower back, down the buttocks and into one or both of the legs, right down to the calf. The pain often gets worse over time and may also be made worse by: sneezing, coughing or laughing, standing or sitting for a long period of time, bending backwards. The accompanied symptoms can include numbness, tingling, muscle weakness, loss of tendon reflexes. The study was funded by the UK National Institute for Health Research Health Technology Assessment program compared clinical effectiveness of management strategies for sciatica and it has shown that there was a statistically significant improvement following disc surgery, epidural injections, nonopioid analgesia, manipulation, and acupuncture. This study has provided new data to assist shared decision-making. The findings support the effectiveness of nonopioid medication, epidural injections, and disc surgery. They also suggest that spinal manipulation, acupuncture, and experimental treatments, such as anti-inflammatory biological agents, may be considered. The findings do not provide support for the effectiveness of opioid analgesia, bed rest, exercise therapy, education/advice (when used alone), percutaneous discectomy, or traction.

How can acupuncture help sciatic pain? First of all acupuncture increasing sciatic nerve blood flow was suggested. Secondly acupuncture improves nerve conduction. Finally acupuncture resumes brain activity in patients with sciatica.

References
Jordan J et al Clin Evid (Online) (2011) pii:118
Shan YL Zhongguo Zhen Jiu (2011) 31:987-90
Li JB et al Zhongguo Zhen Jiu (2013) 33:668-72
Lewis RA et al Spine J (2013)pii:1529-9430
Inoue M et al Evid Based Complemnet ALternat Med (2008) 5:133-43
Schroder S et al Eur J Neurol (2007) 14:276-81
Li J et al Zhongguo Zhong Xi Yi Jie He Za Zhi (2012) 32:1624-7

Thursday, 22 May 2014

Acupuncture helps with restless legs syndrome

Acupuncture helps with restless legs syndrome

Restless legs syndrome is a common condition affecting nervous system. It causes an urge to move your legs and an uncomfortable sensation in your legs and sometimes arms, chest and face. The symptoms include that tingling, burning, itching or throbbing a 'creepy-crawly' feeling, feeling like fizzy water is inside the blood vessels in the legs and cramping in the calf’s or legs. These symptoms can be mild or unbearable and are usually worse in the evening or during the night. These unpleasant sensations can often be relieved by moving or rubbing your legs. It can be difficult to sit for a long period of time. About half of people with restless legs syndrome have some degree of lower back pain. Over 80% of people with restless legs syndrome also have a condition that is known as periodic limb movements (PLM). With PLM, you will have jerky or twitchy leg involuntary movements, usually at night while you are asleep.

There are some conditions which can cause restless legs syndrome such as iron deficiency, low levels of iron in the blood can lead to a drop in dopamine triggering restless legs syndrome. Other conditions causing restless legs syndrome include chronic kidney disease, diabetes,Parkinson’s disease, rheumatoid arthritis, an underactive thyroid gland or fibromyalgia. Some pregnant women may have symptoms of restless legs syndrome which will disappear within four weeks after giving birth. In many cases the causes are unknown.

Acupuncture is used to treat restless legs syndrome in China. There were many case reports with acupuncture treating restless legs syndrome. Acupuncture helps with reducing severity of the symptoms and decreasing the frequency of the symptoms.

A clinical report has shown that acupuncture improves restless leg syndrome

Restless legs syndrome is a common condition of the nervous system that causes an irresistible urge to move the legs and is also associated with involuntary jerking of the legs and arms, in sleep (PLMS). It can also cause an unpleasant crawling or creeping sensation in the feet, calves and thighs. The sensation is often worse in the evening or at night. The symptoms can vary from mild to severe. In severe cases, restless legs syndrome can be very distressing and disrupt a person's daily activities. The symptoms include unpleasant sensation such as tingling, burning, itching or throbbing sensation, a "creepy-crawly" feeling, a painful, cramping sensation in the legs, particularly in the calves. These unpleasant sensations can range from mild to unbearable, and are usually worse in the evening and during the night. They can often be relieved by moving or rubbing your legs. The cause of this condition is not clear. A theory suggested that it is related the falling of dopamine in the part of the brain. Having chronic conditions such as diabetes, parkinson’s disease etc is likely to trigger restless syndrome developed. Iron deficiency anaemia is a trigger for the syndrome. Dopamine agonists including ropinirole, pramipexole and rotigotine are used to treat restless syndrome. Recently a study has shown that acupuncture helps to improve abnormal leg activity. In this study, significant improvement was seen after 4 week and 6 week acupuncture treatments. There were no side effects found during the treatments. Acupuncture is potential treatment for restless leg syndrome.

References
Wu et al Zhongguo Zhen Jiu (2008) 28:27-9
Pan W etc Evid Based Complement Alternat Med (2015) 2015:343201

Monday, 19 May 2014

Cold feet and hands, acupuncture can help.

Do you have icy feet and hands? This sensation is extremely unpleasant. You may feel embarrassed with cold hands when you shake hands with someone. You may have difficulty to fall asleep during the night because of the cold feet. Cold hands and feet can arise due to cold exposure. Cold hands and feet can also be caused by problems with the circulation to the hands and feet or with the nervous system. Conditions causing poor circulation include diabetes, arteriosclerosis, Raynaud’s phenomenon, peripheral vascular disorder and frost bites; neurological disorders such as neuropathy; and decreased metabolism condition such as hypothyroidism. In people with diabetes mellitus, chronic abnormally elevated blood and urine sugar, causes narrowing of arteries and capillaries that impair blood supply to tissues of hands and feet. Arteriosclerosis and peripheral vascular disease result from chronic elevation of blood cholesterol levels that leads to blood vessel narrowing. Raynaud's phenomenon features narrowing of tiny blood vessels as a reaction to nerve sensitivity to cold exposure. Frostbite causes permanent damage to blood vessels that are injured from freezing of tissues. Treating underlying causes are important if there is one found. Other self helps include keep the extremes warm by wrapping them in warm cloth. Stop smoking and reduce caffeine consumption.

Do you know acupuncture can help with your cold feet and hands? Acupuncture can help improve blood circulation in the hands and feet as a result it makes the extremes warm. A study has shown that after acupuncture treatment skin temperature will rise which is probably caused by increased circulation.

References
Svedberg LE et al Complement Ther Med (2001) 9:89-97

Saturday, 26 April 2014

Acupuncture treatment for vulvodynia and vestibulodynia

If you never had pain on the vulva, you can never imagine how painful it is. Chronic vulvar pain is known as vulvodynia which only obtained the name about 30 years ago. It is not unknown now. Channel 4 a British BAFTA-award winning reality medical television programme Embarrassing Bodies introduced this condition vulvodynia. With up to 15% of women suffering with this condition, you can be sure that you’re not alone, if you have vulvar pain. It is a persistent burning or stinging pain of the vulva. It could be constant pain and get worse when under pressure or it could be only painful under pressure such as using tampon or sex. The pain can be only on the vulvar area. It can also spread to the thigh, tummy or back. Women with vulvodynia could have severe period pain, heavy periods, frequent urination and pain and changed bowel habit. Before vulvodynia is diagnosed, other causes of vulvar burning must be excluded. These include fungal, bacterial and viral infections, inflammatory dermatoses such as lichen sclerosus and lichen planus, contact sensitivity and eczema, and lesions such as surgical scars and recurrent fissuring. Vulvodynia can affect women of all ages. The possible causes of vulvodynia may include nerve irritation, abnormal response in vulvar cells to an infection or trauma, genetic factors that make the vulva respond poorly to chronic inflammation,, hypersensitivity to yeast infections, muscle spasms, allergies or irritation to chemicals or other substances, hormonal changes, history of sexual abuse, frequent antibiotic use. It is a distressing condition and affects women’s quality of life. The treatments are limited. Antidepressant and anti-epilepsy drugs can be used to treat vulvodynia and help reducing pain. However the effect is not satisfactory. NICHD-funded research found that amitriptyline (a tricyclic antidepressant) with or without topical triamcinolone (a corticosteroid used to treat skin conditions) was no more effective than self-management approaches (which included components of education and cognitive-behavioral, physical, and sex therapy) in managing vulvar pain, although the number of people in the study was small. Other NICHD-supported investigators conducted a randomized, controlled trial and found that oral desipramine (a tricyclic antidepressants) and topical lidocaine (an anesthetic), alone or in combination, were no better than placebos in helping women with vulvodynia. These drugs have many side effects. Make sure you know the side effects before you take the drugs.

Acupuncture can help treating the vulvar pain. In 1999, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE published a paper by Powell and Wojnarowska about acupuncture for vulvodynia. They selected twelve patients with vulvodynia aged from 18 to 68 years. All had vulvar pain and burning without other abnormalities on examination. All had experienced severe distress and impairment of sexual function. Many had tried suggested treatment without success. These patients were offered weekly acupuncture for ten weeks. As a result of acupuncture, Two patients felt so much improved that they declared themselves 'cured'; three believed their symptoms had improved and wished to continue acupuncture; four felt slightly better and judged acupuncture more effective than any other treatment; and three noted no effect at all. There were no obvious side effects for the treatment. A study from Sweden investigated the effect of acupuncture on vulva vestibulitis. They found that after three month acupuncture treatment patient’s quality of life was improved significantly. More recently Curran et al were using acupuncture for treatment of provoked vestibulodynia which is also a genital pain condition. There were 80 patients involved in this study. After 10 treatments there were significant decreases in pain with manual genital stimulation and helplessness. There were also strong effects for improved ability to have intercourse and sexual desire. Qualitative analyses were overall more positive and showed an improvement in perceived sexual health, reduced pain, and improved mental well-being in the majority of participants.

A new research from Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA has shown that acupuncture treatment significantly reduced vulvar pain in women with vulvodynia. In this study, thirty-six women with vulvodynia were involved. The women were randomly assigned either to the acupuncture group or to the wait-list control group. 10 sessions of acupuncture were offered to women in acupuncture group. Reports of vulvar pain and dyspareunia were significantly reduced, whereas changes in the aggregate FSFI scores suggest significant improvement in sexual functioning in those receiving acupuncture vs. those who did not. Their conclusion is that this was the first randomized controlled pilot study to examine the use of acupuncture for the treatment ofvulvodynia. The acupuncture protocol was feasible and appeared to reduce vulvar pain and dyspareunia with an increase in overall sexual function for women with vulvodynia.

There are some cases that are treated with acupuncture successfully

A 34 year old lady had vulvar pain for 3 years. The pain is worse when pressure is applied such as having intercourse. She always had very painful periods. There was tightness in her thigh and back. She was treated with antidepressant and physiotherapy, but the pain has not improved. There was no pain when passing water and no change with bowl habit. She decided to try acupuncture. After 8 acupuncture treatments, the pain was reduced significantly and she was able to stop taking antidepressant.

A 29 year old lady had vulvar pain for 2 years. There was burning sensation when passing water with frequent urination. The vulva pain was unendurable when having intercourse. It was impossible to use tampon. She also had lower back pain. Her periods were very painful. She was treated with various medications, but the pain was not improved at all. She has heard from a friend that acupuncture can help with her condition and decided to try it. After 3 month treatments, the pain has completely gone. There was no pain when passing water and no intercourse pain.

A 43 year old lady had severe vulvar pain for 1 year companied with period pain and intercourse pain. She had irregular periods and she also had frequent urination and urgency. The pain goes to lower abdomen, thigh and lower back. She took antidepressant, but the pain was still there. Local injection of steroids did not have any improvement. She decided to try acupuncture to see if it helps. After 5 treatments the pain significantly improved and another 10 treatments, the pain was completely disappeared.

References
https://www.nichd.nih.gov/health/topics/vulvodynia/conditioninfo/Pages/treatments.aspx
Powell and Wojnarowska J R Soc Med (1999) 92:579-81
Curran S et al J Sex Med (2010) 7:981-95
Danielsson L et al Acta Obstet Gynecol Scand (2001) 80:437-41
http://www.channel4embarrassingillnesses.com/conditions/vulvodynia/
Schlaeger JM et al J Sex Med (2015) 12: 1019-27


My book can help you understand more about vulvodynia.

Thursday, 6 February 2014

How many eggs retrieved in IVF are good numbers? How can acupuncture help IVF success?

How many eggs retrieved in IVF are good numbers?

IVF becomes a popular technique for infertility treatment since it was invented 30 years ago. During the procedure it is difficult to predict the side effect and success for individuals. IVF success rate is related to egg number retrieved in the procedure. What is the optimum number of eggs for IVF? Is there a connection between egg numbers and live birth rate (LBR)? Ji J et al analysed the data from 2007 and 2011 from total 2455 patients who was undergoing first cycle of IVF treatment. All patients had normal menstrual cycles and were stimulated with a long GnR agonist protocol. Associations between egg number and LBR and miscarriage rate and the rate of moderate-severe ovarian hyperstimulation syndrome (OHSS) were analysed. These patients were divided into four groups according to the egg number retrieved: 0-5, 6-10,11-15 and >15. The fresh embryo transfer LBR and cumulative LBR were assessed. Their data suggested that for IVF cycles stimulated with a long protocol the optimal number of eggs for achieving a live birth is between 6-15. With increased egg number, the incidence of moderate-severe OHSS was increased. There was no significant difference in the miscarriage rates among the patient groups.

There was another research studied the association between egg number and the rates of ovarian hyperstimulation syndrome (OHSS) and live birth in fresh IVF cycles. In this research they analysed data from 256381 IVF cycles. Patients were divided into five groups according to the egg numbers retrieved. The data showed that the LB rate increased up to 15 eggs, then levelled (0-5: 17%, 6-10: 31.7%; 11-15: 39.3%; 16-20: 42.7%; 21-25: 43.8%; and >25 oocytes: 41.8%). While the rate of OHSS became much more clinically significant after 15 eggs (0-5: 0.09%; 6-10: 0.37%; 11-15: 0.93%; 16-20: 1.67%; 21-25: 3.03%; and >25 oocytes: 6.34%). These data showed that retrieval more than 15 eggs significantly inceases OHSS risk without improving LB rate in fresh IVF cycles.

How can acupuncture help with IVF success?

About 1 in 6 couples have difficulty conceiving and seek specialist fertility treatment. There are various treatments available depending on the causes of the infertility. In vitro fertilisation (IVF) is one of the most successful treatments for couples with infertility. Since IVF technique was developed 30 years ago, it helped many couples to achieve pregnancy. In 2003 over 120000 IVF treatment cycles were carried out in clinics in the USA. According to the European Society of Human Reproduction and Embryology, over 300000 treatment cycles of IVF and intracytoplasmic sperm injection (ICSI) were performed each year in Europe. In 2000, about 200000 babies worldwide were conceived through IVF. However, the success rate of IVF is still not satisfactory. IVFalso is expensive, lengthy and stressful. It also affects physical and mental health. To improve IVF success rate, reduce stress, anxiety and depression, acupuncture is a technique used by clinicians. Acupuncture became a popular choice for women undergoing IVF. A survey to study the state of acupuncture treatments in assisted reproductive technology in fertility centers in Swiss, German and Austrian fertility centers has shown40% fertility centers offer acupuncture treatments. In these centers acupuncture points selected were standardized and acupuncture was performed by physician-acupuncturist.

How can acupuncture help IVF?

First of all, IVF with acupuncture support has higher live birth rate. The first report that acupuncture increased IVF success rate was from Stener-Victorin et al in 1999. They applied acupuncture before occytes collection. They found that women in acupuncture group had significantly higher implantation rate, pregnancy rate and live birth rate in IVF embryo transfer. Eric Manheimer et al did first systematic review published in BMJ to investigate the effects of acupuncture on pregnancy rates and live birth rates among women with infertility undergoing IVF. They analysed seven trials involved in 1366 women undergoing IVF. All trials were conducted in four different Western countries and published in English since 2002. In all trials, women received acupuncture immediately before or immediately after the embryo transfer. The acupuncture points selected in all trials are fixed and the acupuncture sessions lasted 25-30 minutes. Clinical pregnancy, ongoing pregnancy and live birth rates were improved. There was no side effect found. Recently a new review found that there were 5 studies involved 463 women who were undergoing IVF. They were given acupuncture twice a week for 2 weeks during the controlled ovarian hyperstimulation period for IVF. The pregnant rate was higher in acupuncture group than that in control group for women undergoing IVF.

Secondly, acupuncture increases embryo implantation potential for patients with infertility. There was a study involved in 210 patients with infertility. These patients with infertility were treated with electroacupuncture and in vitro fertilization and embryo transplantation (IVF-ET). Electroacupuncture was applied before controlled ovarian hyperstimulation and during ovarian hyperstimulation. The levels of human leukocytes antigen-G (HLA-G) in the serum were determined for evaluating embryo implantation potentials. HLA-G may play a role in immune tolerance in pregnancy and its presence in embryo is associated with better pregnancy rates. They found that electroacupuncture can increase HLA-G for the patients undergoing IVF-ET; their HLA-G increased on hCG injection day and on embryo transfer day which indicated increased embryo implantation potential for patients with infertility.

Thirdly, acupuncture improves egg quality. There was a study from Zhongguo Zhen Jiu – an acupuncture journal in China. They studied 60 patients with infertility with poor ovarian response and poor ovarian reserve undergoing IVF-ET. After treatment, in acupuncture group, the symptoms of kidney deficiency were improved; estrdiol (E2) level was higher; egg maturation rate, fertilization rate and good quality embryo rate and implantation rate were higher on the day of human chorionic gonadotropin (hCG) injection. Most importantly the pregnancy rate was increased. Another study investigated the effects of acupuncture on egg quality and pregnancy for patients with polycystic ovary syndrome (PCOS) undergoing IVF. In this study there were 66 patients with PCOS and infertility and undergoing IVF-ET. All fertilization rate, cleavage rate and high quality embryos were higher in acupuncture group than that for control group. There was a study showing Luteal phase acupuncture increased pregnancy rate in women undergoing IVF. 109 patients received luteal phase acupuncture had higher pregnancy rate than those without acupuncture intervention.

Fourthly, acupuncture helps reducing stress and anxiety in women undergoing IVF. Research studied the effect of acupuncture on symptoms of anxiety in women undergoing IVF. 43 patients participated in the study. After 4 week treatment the anxiety score for acupuncture group was significantly lower than for the control group. There is perceived stress on the day of embryo transfer (ET). There was a study on the effect of acupuncture on perceived stress and pregnancy rate on the day of ET. In this study, 57 patients with infertility and undergoing IVF or IVF/ISI were involved. Women who received acupuncture treatment achieved 64.7% pregnancy rate while those who didn’t receive acupuncture treatment had 42.5% pregnancy rate. Women with acupuncture had lower stress score both pre-ET and post-ET compared to those without acupuncture. Women with lower stress score had higher pregnancy rate.

Finally, acupuncture can help after failed IVF. Recently a research paper has shown that acupuncture increased pregnancy rate in women with previous failed IVF cycles. In this study, there were 84 patients participated the study. These patients had at least two unsuccessful attempts of IVF cycles. The predicted success rate for these patients was 10% for this group of patients. Acupuncture was performed on the first and seventh day of ovulation induction, on the day before egg collection and on the day after embryo transfer. The result has shown that the clinical pregnancy rate in the acupuncture group was significantly higher than that in the control and sham groups (35.7%, 7.1% and 10.7% respectively).

Acupuncture reduces pain in IVF egg retrieval

Acupuncture has been used to assist IVF. There are different approaches for the use. Using acupuncture on the day of egg retrieval could help reduce pain. There was a study on this subject to observe analgesic effect and safety of acupuncture in egg retrieval. In this study 316 patients undergoing IVF were divided into two groups acupuncture plus anaesthesia group (146 patients) and a simple anaesthesia (control) group (170 patients). The treatments were carried out 30 min before egg retrieval. They found that pain rating and pain score were significantly better for acupuncture group than that for control group. The incidence rate of abdominal pain at 1hour and 2-5 hour after egg retrieval was lower for acupuncture group. There was no side effect found. Recently there was another study on the effect of acupuncture on pain in egg retrieval. In this study there were 90 patients participated the study. The treatments were also carried out 30 min before egg retrieval. Pain rated index (PRI), visual analogy scale (VAS) and present pain intensity (PPI) were used to measure pain. The result showed that PRI, VAS and PPI immediate after and 1 hour after egg retrieval were significantly lower for acupuncture group than that for control group. They also found that neuropeptide level in follicular fluid is higher in acupuncture group which may be the mechanism of acupuncture analgesic effect on egg retrieval.

References

Nedeljkovic M et al Forsch Komplementmed (2013) 20:112-8

Manheimer E et al (2008) BMJ 8: 545-549

Zheng CH et al Evid Based Complement Alternat Med (2012)2012:543924

Kong FY et al Zhongguo Zhen Jiu (2012) 32:113-116

Chen J et al Zhongguo Zhen Jiu (2009) 29:775-9

Cui W et al Zhongguo Zhen Jiu (2011) 31:687-691

Dieterle S et al Fertil Steril (2006) 85:1347-51

Isoyama D et al Acupunct Med (2012) 30:85-8

Balk J et al Complement Ther Clin Pract (2010) 16:154-7

Villahemosa et al Acupunct Med 2013 31:157-62

Meng P et al Zhongguo Zhen Jiu (2008) 28:451-5

Zhang J et al J Tradit Chin Med (2013) 33:294-7

Steward RG et al Fertil Steril (2014) S0015-0282

Ji J et al Hum Reprod (2013) Jul 25